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Orthopedics > Lecture 3: Fractures > Flashcards

Lecture 3: Fractures Flashcards

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1
Q

What is an oblique fracture

A

A fracture which goes at an angle to the axis

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2
Q

What is a comminuted fracture

A

A fracture of many relatively small fragments

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3
Q

What is a spiral fracture

A

A fracture which runs around the axis of the bone

Happens a lot with a rotational force. skiing

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4
Q

What is a compound fracture

A

A fracture (also called open) which breaks the skin

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5
Q

What is a simple fracture

A

A simple fracture involves a single fracture line through a bone.

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6
Q

What is a greenstick fracture

A

An incomplete fracture in which the bone bends

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7
Q

What is a transverse fracture

A

A fracture that goes across the bone’s axis

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8
Q

What does it mean when fracture fragments are undisplaced

A

Things are not in an abnormal position

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9
Q

What does it mean when fracture fragments are translated

A

Things have slipped

Fragments are not perfectly aligned, but are not at an angle to one another

The fragments may be shifted sideways relative to each other, may override, or may be distracted from each other

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10
Q

What does it mean when fracture fragments are angulated

A

Fragments do not line up in the original shape of the bone, but rather lie at an angle to each other

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11
Q

What does it mean when fracture fragments are rotated

A

Fragments rotated in relation to one another

spiral fracture

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12
Q

What does it mean when fracture fragments are overriding

A

Bony fragments that overlap and shorten the total length of the bone

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13
Q

Explain primary and secondary healing an how it relates to bone

A

Primary healing bones are put together, and there is no distance between the parts that have to heal.

Secondary healing, edges are not put together.

Cortical bone does much better with primary healing.

Spongy bone is good with secondary healing

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14
Q

What is an impacted fracture

A

Fracture in which one broken end is wedged into the other broken end

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15
Q

What is the difference between a closed and open fracture

A

closed (simple) - skin is intact

Open - bone broke through skin and there is a high risk of infection

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16
Q

Why is there a high risk of infection with an open fracture

A

Bone marrow is exposed to foreign bacteria and this can cause a blood infection

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17
Q

What heals faster cancellous or cortical bone

A

cancellous because of its ability of secondary healing

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18
Q

What heals faster epiphyseal fractures or metaphyseal fractures

A

Epiphyseal fractures because of more cartilage

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19
Q

what heals faster a large fracture surface such as a spiral fracture or a transverse fracture, and why?

A

Spiral has more damage but if in the periosteum it would heal faster. With a spiral fracture the body will make a larger response. So a larger surface area will have a larger degree of inflammatory response.

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20
Q

How does displaced bone affect healing

A

Greater displacement means more periosteal injury and slower healing

More damage to the periosteum the more slower healing

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21
Q

How long does it take for a newborn’s bones to heal

A

1 week

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22
Q

How long does it take for a 5 year old and a 10 yr old bones to heal

A

4 weeks and 8 weeks

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23
Q

How long does it take for an adolescent and adult bones to heal

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A

3 months

4 or more months

24
Q

Why do children heal so fast

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A

Periosteum in children
◦ Thicker, Stronger, More adherent, More osteogenically active

Rarely is periosteum torn with fracture in children

Intact periosteum promotes faster healing

25
Cancellous bone heals by
primary and secondary healing
26
cortical bone heals by
only primary
27
What are the phases of bone healing
inflammatory reparative remodeling
28
What happens in the inflammatory phase of healing
Necrosis (Very little necrosis in cancellous bone) Bone macrophages active Hematoma formation 48-72 hours
29
what happens in the reparative phase of healing and what are the 4 stages
Getting continuity back 1) hematoma forms 2) callus forms 3) stage of clinical union 4) stage of consolidation
30
At what stage of healing is the bone safe enough for the person to return to normal life
During the reparative phase in the stage of clinical union. Callus is firm enough to allow no motion 3-4 months After 3-4 months can resume high level activity
31
What is the soft external callus form
periosteum
32
What does the internal callus form
endosteum
33
What happens during the stage of consolidation
immature bone has been replaced by lamellar bone smoothness occurs via Wolff's Law
34
How long does it take for bone to remodel
6 to 12 months
35
What is primary/direct healing
Mechanism of bone healing seen when there is no motion at the fracture site -ex: rigid internal fixation
36
Which healing process Primary/direct or secondary/indirect has a callus formation
secondary
37
Which healing process Primary/direct or secondary/indirect is faster
secondary. Primary is a slow process (unless ORIF)
38
Which type of bone only does primary/direct healing
cortical
39
What is the disadvantage to having a plate inserted
Plate takes all weight-bearing, surrounding areas may get osteoporosis, that is why the plate may be removed later (however not routine)
40
What is secondary/indirect healing
Mechanism for healing in fractures that are not rigidly fixed ◦ Small degrees of movement at the fracture stimulate callus formation Bridging periosteal (soft) callus and medullary (hard) callus re-establish structural continuity Callus subsequently undergoes endochondral ossification Process fairly rapid weeks
41
Why is secondary/indirect healing fast
lots of blood supply
42
What happens during the remodeling phase and how long does this take?
bone remodels back to original shape (no scar) 6-12 months
43
What is osteomyelitis
inflammation of bone and muscle tissue
44
Soft tissue injury
Muscle contusion, hemorrhage, myositis ossificans | Ligament sprain / tear
45
Peripheral nerve injury
compression, contusion, traction
46
What nerves are most at risk?
common fibular, ular, radial common sites
47
What are three types of vascular injuries
compartment syndrome Venous injury Arterial injury
48
What is compartment syndroms
It is when to much pressure builds up (progressive edema) in a fixed amount of space. This compromises circulation --> necrosis and nerve damage
49
What are some specific complications of healing
malunion deformities issues with long bones
50
What are 3 types of malunions
Delayed union Nonunion Pseudarthrosis
51
What is a delayed union
slow healing
52
What is a nonunion
does not come together
53
What is a pseudoarthrosis
Fibrous joint: | insead of the bone healing nicely, it might have some movement when there shouldn't be movement
54
What are some complications that can happen with long bones (3)
angulation shortening rotational
55
Treatment principles for fractures
Do no harm Accurate diagnosis critical ``` Specific aims of treatment ◦ Relieve pain ◦ Fracture reduction ◦ Facilitate bony union ◦ Restore function ``` Wolff’s law Consideration of lifestyle
56
What is the treatment for closed fractures
Protection alone ◦ i.e. sling, NWB Immobilization Closed reduction ◦Manipulation & immobilization (most common) ◦ Traction & immobilization ◦ External fixation Open reduction internal fixation
57
what is the treatment for open fractures
Wound care Open reduction vs. closed reduction Immobilization vs. fixation

Orthopedics (12 decks)

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